Provider Demographics
NPI:1801028394
Name:MASHAMBA, TENDAI AMANDA
Entity Type:Individual
Prefix:MS
First Name:TENDAI
Middle Name:AMANDA
Last Name:MASHAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 MILL SPRINGS CMN
Mailing Address - Street 2:APT 215
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4280
Mailing Address - Country:US
Mailing Address - Phone:140-862-7225
Mailing Address - Fax:
Practice Address - Street 1:1843 MILL SPRINGS CMN
Practice Address - Street 2:APT 215
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4280
Practice Address - Country:US
Practice Address - Phone:140-862-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program